i went to my patient's room to start iv and noticed that her picc line is pulled out about 3cm from her arm.. i aspirated back and i was able to get blood return. does it mean i can still use it or is it out of the position and i need another chest x-ray? what do you guys do in this situation?
Jun 29, '09
I'm guessing you work in a hospital setting? I don't really have much advice for you, but I work in (and love) home infusion. We do weekly dressing changes on PICC lines, & we measure (& chart) the extension amount at each visit. We also measure & chart the circumference of the pt's arm weekly, because swelling in the arm could alert you to a problem with the line. We don't generally worry about how much is showing (unless it is a lot more than at the previous visit) as long as we can obtain a positive blood return. When was the PICC line placed on your pt? I'm thinking it was probably done with x-ray verification? When was the dressing changed last? Is the line sutured into the arm, or is a Statlock used instead? Typically, the line will come out a little with the dressing change, because of the stickiness of the Tegaderm when it is lifted. Sorry I can't really help you without knowing the answers to these questions...good luck to you & have a wonderful day! Hopefully someone else on here will be better able to provide you with the answers you are searching...
Last edit by medicmama921 on Jun 29, '09
: Reason: misspelled word
Thanks!!! sure it probably still is in the SVC...probably mid...and if pt has a long SVC may even still be in the low..The SVC is good.......IV nutrition with 10% glucose or less would be PPN and yes you could give that in a peripheral vein...I still dislike it though b/c you have to re-start that IV practically every day...but its OK for an urgent need..then we get something better...Ok yes the vesicant/irritating drug thing can get confusing....so think about it this way...say you are giving Dopamine and your PICC get pulled out enough to be in the Subclavain vein and you confirmed that by CXR and the PICC team is gone......are you going to start a PIV b/c the drug is irritating.....NO...it is still better to give it in that large vessel......get an order to use it there...and then replace it ASAP.....remember you get much better hemodilution in those large vessels...there are really very few things YOU MUST give centrally....TPN and Continuous vesicant chemo...that is it.....NOW that is not to say that there are MANY MANY drugs that should be infused via a central access...such as Amio.....3 and 5 percent NS.....Dopamine and Dobutamine....but you do what you have to do at the time...and then get a better access ASAP...if you still need it...think not only delivering the drug and IVF..think vein preservation
Last edit by iluvivt on Jun 29, '09